Why you should be interested in Biblical counselling
5 MINUTE READ
I felt that my calling was for whole-person care as a general practitioner, with a special interest in mental health and counselling. This led me to seek further theological training, wisdom, and mentorship. I recalled that my pastor and his wife had shared about the personal transformative work that God had done through an online course called “Dynamics of Biblical Change”, housed at the Christian Counseling and Education Foundation (CCEF).1
The more I read from the lecturer David Powlison, the more intrigued I became. I learned that Biblical counselling was a movement born as a response to encroaching secular psychotherapies that were trying to hedge out the role of pastoral ‘soul care’ (as the word ‘psychotherapy’ means ) in the church in the Western world.2
From the very first lesson, I knew there was wisdom to be found. David opened each class by asking the class to stand and sing a hymn together, the first being “Fairest Lord Jesus”. He then went on to exegete the hymn, reflecting on each stanza! It was a delightful surprise and refreshing to my ears, heart, and soul. For the rest of the class, he would explore the Biblical model of change, which has worship as its goal. This model promised deliverance from all forms of evil whether physical or spiritual, being alive and strong (again physically and spiritually) liberated from all fears, sorrows, and loss, being eternally blessed, beautiful in re-created bodies, and a truly good person without sin, pointing towards the final purpose of being like Christ when He returns3 – picture Revelation 21 in the microcosm of a person within a multitude of nations!
At one point David quoted T.S. Eliot: “Where is the knowledge we have lost in information? Where is the wisdom we have lost in knowledge?.” There are a thousand different distractions that steer us away from seeking divine wisdom. There’s something about true wisdom that is beautifully simple, but not simplistic. It captivates you and stops you in your tracks. One of the distinctive things I learned during my studies in Biblical counselling was how to wisely love all people, while considering my role and relationship with them. To capture the complexity of a person and their situation is like seeing how the rising sun illuminates the contours of a varied landscape , and asking the Great Trail-setter to reveal the path to walk down.
Maybe you’ve come across a patient like Taylor* – she’s single, in her early 20s, and comes with labels like ‘borderline personality disorder’ or ‘complex post-traumatic stress disorder’. She wants help for her anxiety and panic attacks.
Or maybe you’ve met someone like Brett* – he comes in agitated and loud, reveals his history of methamphetamine abuse because you ask him, and he seems both desperate and demanding as he asks you to help him through both alcohol and methamphetamine withdrawals.
And then there’s Barbara* – she’s nearing 80 and her chronic fatigue syndrome and generalised anxiety disorder are taking a downward turn since her husband was diagnosed with Alzheimer’s dementia.
Using these case studies, I offer five ways in which the use of Biblical counselling helps me view and respond to these three people.
- Biblical counselling gave me the theological framework for how to be an instrument of God’s grace as a general practitioner. It helped me to practise with an ethic of love and humility4. Love compels me to be compassionately curious about Brett’s desire to get help at this moment in time. Humility compels me to recognize that I am more similar to my patients than different; I experience the same struggle between sin and suffering and sainthood5, whether I’m speaking to a 9-year-old or a 90-year-old image-bearer. I am not above them, I am walking alongside them. This means I can rejoice with those who rejoice, and weep with those who weep, and mourn the effects of sin while also rejoicing when steps of repentance are made. One of the key features of an effective therapeutic relationship is the bond between the helper and the person being helped. It is a relationship built on compassion, which is something that arises out of a working ethic of love and humility.
Humility reminds me that I can speak wrongly and incorrectly; it gives me the grace to ‘edit’ what I say, or apologise when I say something hurtful or harmful. For example, humility implores me to ask if I might have wrong assumptions, either due to cognitive biases as is known in clinical reasoning, or the theological idea of ‘the noetic effects of sin’6.Questioning my assumptions about Taylor’s request for benzodiazepines for her panic attacks drives me to look at her prescription history. I realise that she has only been ‘managed’ by past medical practitioners prescribing medication; there has been no effort to maximise trauma-informed psychological care and dialectical behavioural therapy. This methodology of love and humility undergirds all that we do. Active listening isn’t novel, it’s a common grace, but we can practise it faithfully and repent where we do not.
“This methodology of love and humility undergirds all that we do. Active listening isn’t novel, it’s a common grace, but we can practise it faithfully and repent where we do not.”
Seeing myself as an instrument in the Redeemer’s hands7 allows me to see that there is a ministry in naming – when we, imitating the creator God, name the correct diagnosis, we are using our power for the good of the person we are speaking to. Likewise, we need to speak the truth when we are unsure about our diagnosis. There is a ministry in facilitating insight, in providing an “Aha!” moment of clarity where the connections are made between symptoms and diagnosis; where Barbara realises that her anxiety and anger towards her husband’s declining memory is a grief process. There is a ministry in helping someone to face the depression from which they have been turning to alcohol for escape. There is a ministry in teaching someone about their condition, in delineating between right and wrong, between wise and foolish decisions about their physical or mental health and relationships. Through all these ministries, we aim to incarnate Christ towards our patients.
2. Biblical counselling taught me Biblical categories by which to see people more deeply and broadly, beyond the diagnostic categories and labels we work by – to see them as humans and not ‘projects’ or ‘problems’. For example, those who have experienced trauma have had a ‘brush with death’ and have been ‘wounded’. This gives us a Biblical image that deepens our compassion and understanding of what the person in front of us has experienced and to understand their response to that life-altering encounter that has left a comprehensive effect on both body and soul. This Biblical imagery also helps to remind me of Scripture that teaches me how to respond to someone who has experienced trauma. The current recommendations from trauma-informed healthcare is to provide a relationship of safety. However, Isaiah 61 offers a richer picture of what we can offer because “the Spirit of the Lord is upon me”. It gives us a Christ-like response to someone whose heart has been wounded, taken captive and held prisoner by this experience, and brings not only safety, but also a presence and words of comfort and life.
Another helpful term is that of ‘embodied souls’, which summarises the Biblical anthropology for “What is a human?” or more personally, “Who am I?”. In simple (but not simplistic8) terms, we bear the image of God in both our outer (body) and inner (soul) selves. This inner self is more often named the ‘heart’ in the Bible. It is from the heart that sin arises.
Isn’t it interesting how even in the bio-psycho-social-cultural-spiritual model of a person, the heart is not addressed. By contrast, the Bible describes us as being active moral agents who are always responding. When I understand my patients as ‘active moral agents’ rather than neutral ‘blank slates’, I can respond to them with more specific wisdom and compassion, and am dependent on His transforming grace on their hearts. Instead of deferring to ‘autonomy’ (one of the pillars of medical ethics), understanding that the heart lies at the base of all desires and decisions then provides an access point to appeal for decisions to live either wisely (towards God’s design) or foolishly (away from God’s design).
“Biblical counselling reminds me that addiction is not only biological and painful, but also sinful, wherein lies an opportunity for redemption.”
An example of how this works in practice is in the large proportion of the patients I see who are affected by chronic pain caused by abuse, neglect, drug abuse, and trauma. I can forget to see them beyond their biological addiction and psychosocial circumstances. Biblical counselling reminds me that addiction is not only biological and painful, but also sinful, where lies an opportunity for redemption. In addition to treating Brett’s physical symptoms and psychological pain, I need to speak to his moral agency as well. This can be framed as being wise or foolish. Those who are foolish include those who are drug-dependent, some merely seeking but others demanding. Safeguards are needed, such as staged supply of medication.
Another helpful Biblical framework for a person’s heart disposition comes from 1 Thessalonians 5:14.9 There is a difference amongst those who are faint-hearted or timid who need encouragement, those who are weak who need help, and those who are idle who need warning. And all of these different categories of people require patience. The complexity of the human heart means that several categories may co-exist in a person, but there may be a predominant leaning in a particular season of their life. With someone who is presenting as faint-hearted or weak, I find the approach of starting with the good, then moving to the hard and sad, before working on the bad, is helpful.
Finally, the framework of sinner, saint, and sufferer5 has been extremely helpful for me in working with Christians in the church context of discipleship or in a Christian counselling context. The person in front of me is made in the image of God, but is also a sinner in need of salvation and redemption. They are sufferers afflicted by the effects of the Fall on their body and mind and relationships. Having been created as relational beings, how can redemption be brought into each aspect of their life? For example, Barbara is at a time in her life where addressing her as a sufferer and saint will be of most help to her before addressing any sinful responses to her own illness and her husband’s declining health.
3. Biblical counselling taught me metaphors on how to both understand and teach my patients how to recognise the patterns of redemption and wilful sin. Metaphors found in the Bible that remind us of what the deceitfulness of sin looks like include terms familiar to us: asleep (Eph 5:14), drunken (Ps 107:27), like an unreasoning animal (2 Pet 2:12), those with a madness in our hearts (Eccl 9:1). Each person is either living aware of their role in God’s story of redemptive history or is suppressing the truth of the knowledge of God (Rom 1:18-32), thereby living by common grace (Mt 5:45). When I am speaking to a non-believer, I can sow seeds that could be preparing their hearts for the gospel message; it is pre-evangelism, so to speak. After meeting Barbara the first time, I realised that she did not know the lordship of Christ, but knowing that the Bible reveals and speaks into the deep longings of the heart, I was still able to ask if she had a spirituality that gives her strength or hope. I can also ask Brett about what his hopes and dreams and ambitions are, and encourage wherever I see good fruit or progress in his decision-making. When it comes to addiction, the overarching metaphor is of war, so I aim to give people who struggle with slavery to addictions both an experience of and love for the grace of Christ.10
4. Biblical counselling helped me to see myself as a ‘co-belligerent‘11 alongside my colleagues who counsel from other psychotherapy modalities, humbly recognising the utility they can offer at the right time and place to the appropriate person for their flourishing. Some tools I use myself include cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and trauma-informed psychotherapy. I always strive to know the history and founders of each therapy in order to understand their utility.
Additionally, Biblical counselling helped me see the role I have as a GP alongside my role in the local church as part of the body of Christ. I am one member who can be getting to know the hospital chaplain or the local pastor and refer patients to them. I see my pastors as carers of the soul, and we in healthcare also care for the embodied souls within our jurisdiction.
I believe there needs to be more training and licensure of Biblical counsellors who work within the ecosystem of the local church or as a parachurch ministry, able to minister God’s Word privately. This idea is captured by CCEF’s vision of “restoring Christ to counselling, and counselling to the church”.
5. Biblical counselling helped me aim towards a true assessment of motives in order to facilitate change for the better. Dr Thomas Sigley says: “Biblical counselling and Biblical evangelism are cut from the same piece of cloth: the same truth about God, the same truth about human nature, the same powerful grace. When rightly understood, the outward actions, the fixed ideas, and the pressing emotions of non-Christian counsellees show that they live under the influence of the world’s lie: “You are your own god.” Counselling and evangelism dig out this lie in its particular forms, and expose it before the eyes of the unbeliever. […] Our techniques must show people the relationship between their nature and their behaviour, the link between sin and its consequences, the relevance of God’s grace to our real need.”12
While there are many other helpful benefits to the body, mind, and soul from other forms of psychotherapy, it is from a Biblical worldview that someone’s heart’s desires can be accurately assessed. The heart and its motives can serve as the ‘point of contact’ to present a Biblical worldview.
Practically speaking, I see an immense need to be wise as a serpent and innocent as a dove because of the secular context in which I counsel patients. However, if the offer for Biblical counselling was taken up by a non-Christian, there would be ample opportunity to discuss worldview questions and introduce a Biblical worldview. Since we are creatures who have been created by their Creator with a heart’s desire to know Him, by coming to ask for help with a specific problem, the conversation could be led to approach the questions “Who am I?”, “What’s wrong with the world and my life?” and “What’s the solution?” Journeying with someone wrestling through these questions would very much be an opportunity to ask our Creator to open the eyes of the heart of a blind person, or breathe life into a dead person. When we face opposition or rejection of this presentation, we face each of these people with grace, knowing they are suppressing the image of God in them.13
Though I’ve finished my degree in Biblical counselling, I am excited to be part of a wider body of members who are using this wisdom with such versatility in many structures of care — in churches, missions organisations and parachurch ministries. I’ve not come across such a diversity of classmates as I did in my Biblical counselling studies. In our recent Brisbane chapter, I met a lawyer, a military chaplain, a previous Church Mission Society (CMS) missionary, an associate pastor, a previous design consultant, a part-time anaesthetist, and a previous psychiatrist in the same room. I highly commend anyone reading this article to watch the sample lecture from CCEF’s “Dynamics of Biblical Change” course and let God do his heart transformation with wisdom and compassion. For out of the overflow of your heart, the mouth speaks, and the instrument of grace can be used by the Redeemer.
*These 3 clinical vignettes are composites of different patients I’ve met over the past 3 years.
Dr Eleasa Sieh
Dr Eleasa Sieh works as a GP who specialises in mental health and counselling in Brisbane. She finds it a privilege to be able to continue doing so as a means of witnessing God’s specific and common grace everyday, including in her own embodied soul, relationships, and the global Church community.
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- “Dynamics of Biblical Change” course, Christian Counseling and Education Foundation. Accessed at https://www.ccef.org/course/dynamics-of-biblical-change/ on 12th September 2023.
- David Powlison, The Biblical Counseling Movement (Greensboro, NC: New Growth Press, 2010).
- David Powlison, “Dynamics of Biblical Change”, Lecture 1, Christian Counseling and Education Foundation
- Dr Todd Stryd, Lecture 2 in “Counseling Observation A”, Christian Counseling and Education Foundation
- This is taken from Dr Michael Emlet’s framework of the Christian as a sinner, sufferer, and saint found in his book Saints, Sufferers, and Sinners: Loving Others as God Loves Us (Greensboro, NC: New Growth Press, 2021).
- The noetic effects of sin is a theological concept I learned in the counselling course “Human Personality” that has now been reworked as “Applied Theology of the Person”. Accessed at https://www.ccef.org/course/applied-theology-of-the-person/ on 12th September 2023.
- Paul Tripp, Instruments in the Redeemer’s Hands (Phillipsburg, NJ: P&R Publishing Company, 2002).
- This quote from Oliver Wendell Holmes was used by David Powlison to describe the clarity that simplicity brings out of complexity: “I would not give a fig for the simplicity this side of complexity; but I would give my life for the simplicity the other side of complexity.”
- David Powlison, “Familial Counselling”, Journal of Biblical Counselling, Winter 2007, 2-16.
- Alasdair Groves, “Sexual Addiction seminar” (handout, Westminster Theological Seminary, Glenside, PA, date).
- William Edgar, “Christianity and Culture” (course notebook, Westminster Theological Seminary, Glenside, PA, date).
- Dr Thomas Sigley, “Evangelism Implosion: Reaching the Hearts of Non-Christian Counselees”, Journal of Biblical Counselling, Vol 17 (1), Fall 1998, 7.
- One of the mandatory courses as part of the Masters of Arts in Counseling degree program is “Introduction to Apologetics” which featured lectures by Dr William Edgar whose book “Reasons of the Heart: Recovering Christian Persuasion” (Phillipsburg, NJ: P&R Publishing, 1996) was part of the curriculum.